Cholecystitis is an inflammation of the gallbladder that is usually caused by gallstones blocking the cystic duct. There are three main types: acute calculous cholecystitis caused by gallstones; acalculous cholecystitis seen in critically ill patients without stones; and chronic cholecystitis from repeated acute episodes. Symptoms include pain in the right upper abdomen, fever, jaundice, and Murphy's sign on palpation. Diagnosis involves blood tests, imaging like ultrasound and CT. Treatment focuses on pain relief, antibiotics, and sometimes surgery to remove the gallbladder for severe or recurrent cases.

1. CHOLECYSTITIS
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing
Sciences

2. Definition :
 It is an inflammation of the gallbladder.
 More than 90% of cases are associated with cholelithiasis caused
from blockage of cystic duct by gallstones.
 It may be acute calculous, acalculous or chronic cholecystitis.

4. Etiology / Types:
1. Acute Calculous cholecystitis :
- More than 90% of cases are acute & caused due to gallbladder
stones obstructing bile outflow.
- Bile remaining in the gallbladder initiates chemical reaction,
autolysis and edema.
- Escherichia Coli is the most common bacteria involved. Other
bacterias are Streptococci, Salmonella & Klebsiella may stimulate
onset of inflammation.

5. 2. Acalculous cholecystitis :
- There is no stones in biliary duct & it accounts for 5 – 10% of
cases.
- It is seen in people who are hospitalized & critically ill.
- It is associated with conditions like vasculitis, chemotherapy, major
trauma, extensive burns and following surgery.

6. 3. Chronic Cholecystitis :
- It occurs after repeated episodes of acute cholecystitis & is always
due to gallstones.
- It may be asymptomatic.
- It leads to number of complications like gangrene, perforation,
fistula formation.

7. Pathophysiology :
Blockage of the cystic duct
Increase pressure within the gallbladder
Damage the gallbladder wall & becomes edematous
Inflammation & swelling of gallbladder (bile / pus)
Reduce normal blood supply & cell death

8. Clinical Manifestations :
- Asymptomatic in the beginning
- Abdominal pain in the right upper quadrant / epigastric region
- Murphy‘s sign : ask the patient to take in and hold deep breath,
palpate the right subcostal area. If the pain occurs on inspiration
(inflamed gallbladder comes in contact with examiner’s hand), then
murphy’s sign is positive.
- Jaundice
- Fat intolerance
- Dyspepsia
- Dark coloured urine & stool
- Flatulence

10. Diagnostic studies :
- History collection & Physical examination
- Liver Function Test
- CBC (Leucophilia)
- C – reactive protein
- Serum Bilirubin
- Abdominal X-Ray
- Ultrasonography
- Endoscopic Retrograde Cholangiopancreatography

11. Complications :
o Subphrenic Abscess
o Cholangitis
o Pancreatitis
o Biliary cirrhosis
o Rupture of gallbladder
o Fistula

12. Management :
Conservative therapy:
• Aim : to control pain, controlling further infection & maintenance of
fluid & electrolyte balance.
• Treatment focuses on symptoms.
• NPO
• Gastric decompression to reduce nausea & vomiting.
• Antiemetics (promethazine / phenergan)
• Analgesics (Meperidine)
• Administration of Fat Soluble Vitamins (A,D,E & K)

13. - Anticholinergics
Ex : Dicyclomine, they decrease gallbladder stimulation.
- Antispasmodics
Ex: scopolamine, they block acetylcholine, that signal muscle to
contract.
- Antibiotics
Ex: Ampicillin, Ciprofloxacin, imipenem, Levofloxacin.

14. Nursing Management :
- Acute pain, abdomen, related to discomfort.
- impaired gas exchange related to decreased thoracic excursion.
- Impaired skin integrity related to altered biliary drainage.
- Imbalanced nutrition, less than body requirement related to
inadequate bile secretion
- Deficient knowledge related to poor self care activities.

15. Thank you